In 2018, 48,344 people committed suicide in the United States; their numbers and ages ranged from 2 eight-year-olds to 1,248 people aged 85 and older (Centers for Disease Control and Prevention, 2020). It’s likely that most of these individuals had family members who could be called “survivors.”
What impact does the suicide of a relative have on the survivors? According to de Groot and Kollen (2013) and Jordan and McMenamy (2004), the repercussions can include
- Depression and anxiety
- Somatic complaints
- Irritability and rage
- Avoidance, disbelief, and detachment
- Guilt and shame
- Traumatic stress disorder
One of the most serious consequences for survivors is suicidal sequelae, including ideation, plans, and attempts. Some explain this as a function of psychic pain which is different from depression and helplessness but more akin to anguish and despair (Campos, Holden, & Santos, 2018).
Although the loss of a relative from suicide can be extraordinarily painful, who the decedent was and who the survivor is have psychological importance. For example, children whose parent died by suicide tend to have more psychological distress (e.g., depression, anxiety) and behavioral problems (e.g., school performance, withdrawal, outbursts, social adjustment issues) than children whose parent died from a natural death (Cerel, Fristad, Weller, & Weller, 1999). The difference may be attributed to the shame the child feels because of the stigma of suicide as well as not being able to understand why their parent died by suicide.
The effect on adult survivors is also quite painful and distressing. For those who lose a spouse, their depression may be greater than for those who lose a sibling or a parent because of the loss of intimacy, dependence, and support after the death (de Groot & Kollen, 2013).
Jaques (2000) discusses several issues that impact the ability of adult survivors to cope and work through the suicide of a family member.
- Do surviving family members offer support for each other or is blame and resentment expressed?
- Can adult survivors find support from others they know or are feelings of shame and guilt preventing them from talking to persons outside the family?
- Do survivors believe they can seek comfort and strength from their religion?
- Do men and women deal with the death differently because of society’s expectations? (For example, women expressing their feelings openly and men masking their feelings while experiencing great internal distress.)
- Does the survivor have social and religious sources that can offer healthy support and not be subjected to judgment and misunderstandings regarding suicide?
Most mental health professionals agree that recovery from bereavement entails accepting the reality of the loss and processing these emotions. Children need to be helped in finding a way to adjust and understand the death of their parent. Communications about the death should be age-appropriate but also realistic. Moreover, they will need to feel assured that someone will care for them, physically and emotionally. Addressing these issues can help the child grieve—an emotion that can present at various stages in their lives (Mitchell, Wesner, Brownson, Dysart-Gale, Garand, & Havill, 2006).
There are child and adult survivors whose bereavement is more serious than “expected” grief, and for them mental health intervention is recommended, especially if they are having suicidal thoughts. It is important that survivors seek therapists who are experienced working with people whose family members died by suicide. Treatment may include cognitive behavioral therapy to help reduce serious grief reactions, medications for problematic psychiatric symptoms, and family therapy to help members express their feelings and receive validation and support from each other.
Jaques (2000) noted that Dunne, McIntosh, & Dunne-Maxim (1988) offered several suggestions therapists can consider when treating surviving family members, including
- Understand that you will survive, even if you don’t think so.
- Recognize that your feelings, while intense and overwhelming, are normal and will diminish.
- Accept that feeling angry (at whomever) is okay.
- Thinking about suicide does happen, but it does not mean you will act on it.
- Be aware of your pain and your physical reactions (e.g., sleeplessness, loss of appetite) to the death.
- Be patient and give yourself time to heal.
- Do not make major life decisions right now.
- Come to realize that your life has changed permanently, but you can move on.
- Seek help from people who will listen and not judge.
For survivors, the need to mourn in an adaptive manner is critical in promoting the ability to move forward. In fact, some researchers believe that positive psychological change can follow from major life crises. Tedeschi and Calhoun (2004) developed a theory called “post-traumatic growth.” They explain that after a person experiences a significant negative life circumstance, the person’s attempts to adapt to the high amount of psychological distress can bring about post-traumatic growth. Such growth is not the same as “resilience, hardiness, optimism, and a sense of coherence”; these characteristics contribute to the individual managing the adversity, whereas post-traumatic growth creates a change in the individual beyond adaptation. The struggles people endure by their attempts to cope and survive in their “new world” after the trauma is what leads to their growth. This is not to say that their sadness or distress disappears; however, Tedeschi and Calhoun found that it can lead to growth in the form of:
- greater appreciation of life and a changed sense of priorities.
- warmer, more intimate relationships with others.
- a greater sense of personal strength.
- recognition of new possibilities or paths for one’s life.
- spiritual development.
The death of a family member by suicide can have a profound effect on survivors. They will need positive support from others and time to heal. Their adaptation depends highly on their ability and desire to deal with their loss and their bereavement, in addition to recognizing their growth from the struggles they face.
Campos, R. C., Holden, R. R., & Santos, S. (2018). Exposure to suicide in the family: Suicide risk and psychache in individuals who have lost a family member by suicide. Journal of Clinical Psychology, 74(3), 407-17. DOI:10.1002/jclp.22518
Centers for Disease Control and Prevention. (2020). 2018, United States suicide injury deaths and rates per 100,00. https://webappa.cdc.gov/cgi-bin/broker.exe
Cerel, J., Fristad, M. A., Weller, E. B., & Weller, R. A. (1999). Suicide bereaved children and adolescents: A controlled longitudinal examination. Journal of the American Academy of Child & Adolescent Psychiatry, 38(6), 672-9. DOI:10.1097/00004583-199906000-00013
de Groot M., & Kollen, B. J. (2013). Course of bereavement over 8-10 years in first degree relatives and spouses of people who committed suicide: Longitudinal community based cohort study. British Medical Journal, 347(7928), 1-11. doi: 10.1136/bmj.f5519
Dunne, E., McIntosh, J., & Dunne-Maxim, K. (1988). Suicide and its aftermath. Norton.
Jaques, J. D. (2000). Surviving suicide: The impact on the family. The Family Journal: Counseling and Therapy for Couples and Families, 8(4), 376-9. doi.org/10.1177/1066480700084007
Jordan, J. R., & McMenamy, J. (2004). Interventions for suicide survivors: A review of the literature. Suicide and Life-Threatening Behavior 34(4), 337-49. DOI:10.1521/suli.34.4.337.53742
Mitchell, A. M., Wesner, S., Brownson, L., Dysart-Gale, D., Garand, L., & Havill, A. (2006). Effective communication with bereaved child survivors of suicide. Journal of Child and Adolescent Psychiatric Nursing, 19(3), 130–6. doi: 10.1111/j.1744-6171.2006.00060.x
Tedeschi R. G. & Lawrence G. Calhoun, L. G. (2004) Target article: Posttraumatic Growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15(1), 1-18, DOI: 10.1207/s15327965pli1501_01